2024 NPI Endeavors

NPI ENDEAVORS WWW.NASHVILLEPSYCHOTHERAPYINSTITUTE.ORG

October 2024

What is NPI? The Nashville Psychotherapy Institute is a 501(c)(6) nonprofit, professional organization.

Founded in 1985, NPI now boasts 360+ members.

The purpose of NPI includes providing continuing education programs for practicing psychotherapists and promoting interdisciplinary dialogue and support among the various psychotherapeutic professions. NPI’s searchable therapist directory is a way for members to market their practice, make referrals and connect with patients.

NPI strives to cultivate respect within our community for people of all abilities, ages, countries of origin, ethnicities, genders, gender expressions, races, religions, and sexual orientations.

01/27

HISTORY OF NPI

Letter from the Chair Hello, NPI members and friends of NPI! Welcome to our new annual publication– NPI Endeavors. I hope you enjoy the thoughtprovoking articles herein. As Board Chair this year, I want to tell you that NPI has made significant strides in improving its purpose and vision. While we primarily are an educational entity that provides Continuing Education for our participants, we also strive to provide an environment that invites networking, Michael Murphy, L.C.S.W., C.G.P. friendship, and support. We have continued to keep our “Reset Statement” a significant part of our focus, and this Reset Vision is now part of every committee meeting, every new initiative, and a significant factor in selecting speakers. Are we paying attention to BIPOC and LGBTQIA2S+ communities? Are we providing an atmosphere and culture that feels welcoming and safe for our entire Nashville community? It’s the basis for our new Host program where new and first-time attendees are greeted by “seasoned” NPI members at luncheons. Another change we’ve made is recognizing the time and work put into presentations by paying an honorarium to presenters at our luncheons and for our Social Justice events. Hurray! That was a long time coming.

(Thank you, Valerie Martin).

And speaking of time ...

As Chair-Elect last year, I was tasked with choosing a theme for 2024. I chose “Time” as our theme. Time affects each of our lives, and it manifests in many issues that we address with our clients. And so, I began. For a variety of reasons, I suddenly felt the focus and energy I used to feel when I lived in the D.C., area where I had a theatre company and produced and/or directed a variety of plays. I was eager to begin to plan and shape the “season” for NPI. What will the plays be, and who will be the directors? I am so grateful to the wonderful people who accepted my request for them to present at our luncheons. I want to thank and acknowledge them here: David Sacks, Ph.D. “Wow, That Went Fast! Time Dilation and Flow in Therapy” LJ Ratliff, L.C.S.W. “Generational Healing and Family Constellations Work: The Body as Time Traveler” Volney Gay, Ph.D. “Empathy and It’s Five Essential Skills” Rich Gorman, LPC “Chaos and Clarity: Helping Clients Live Well with Cancer” Christal R. Pennic, LPC “Grief and Bereavement: What Does it Mean To Grieve Well?”

Adam Breister, LPC “Stuck at Home: Supporting Adult Dependent Children” Linda Manning, Ph.D. “When Trauma Stops Time: Understanding and Working with Implicit Memory”

02/27

Letter from the Chair (continued on page 21)

More than 20 million people in the US have a substance use disorder.

Whether you work with individuals, couples, or groups, there is a VERY good chance your clients (or you) are impacted by this topic.

This workshop has something for almost everyone NOT JUST THOSE WHO WORK SPECIFICALLY IN THE SUD FIELD.

FULL PROGRAM DESCRIPTION & REGISTRATION INFO

Welcome onboard, John!

Fees: $219 members/$249 non-members $109 students Scholarships Available (Click Here to Learn More) GENEROUSLY SPONSORED BY:

03/27

REGISTER FOR FALL WORKSHOP

From the Chair-Elect As the clock strikes midnight on 12/31/24, we enter the 40th year of the Nashville Psychotherapy Institute.

What a Ruby Revelation! And a cause for celebration and reflection.

Where have we been and where are we going?

Does NPI continue to meet the needs of members

Tiffany Davis, LCSW

as it set out to do when formed in 1985? How do we adapt and embrace the changes in the psychotherapy field and in the

Nashville mental health community? These are questions and reflections that your Board and committees ponder as we make decisions on programming and opportunities for engagement.

Within this context, planning for 2025 has encompassed the theme for 2025: Creating Meaningful Change: Evolving with the Times. Our luncheons will kick off the 2nd Friday in January with Ingrid Cockhren, M.Ed. Her presentation is “Is Anti-Pathology the Key to Mental Health Equity? Unpacking the Impact of Scientific Racism & Scientific Colonialism in the Field of Psychology”. Jessica Hyne, LPC will lead us in our February luncheon on "From fragmentation to freedom and wholeness: Healing from shame and high control religious groups through the lenses of Somatic Experiencing and Internal Family Systems", and in March Laurie Miles, LCSW will discuss “Understanding Sexual Addiction: Realities and Treatment”. We are excited about a wide range of topics that hopefully speak to the meaningful change psychotherapists facilitate within their clients and within themselves as practitioners.

Other exciting happenings are occurring in the first quarter of the year: our Bi-annual Connections Retreat, February 22-23, 2025, in St Mary’s Sewanee and an evening gathering to officially celebrate the 40th Anniversary of NPI at the home of David McMillan and Marietta Shipley on April 24, 2025. The Connection Retreat, which is themed “Creating Meaningful Connection” is an opportunity to earn some CEUs, engage with members/friends, relax in the beauty of the Tennessee plateau and reflect on the value of NPI in one’s professional life. The April party will allow us all to toast and fete NPI’s legacy established in 1985.

Continuing networking opportunities exist monthly beyond luncheons. Krista Gray and the programming committee worked to get NPI at Night going this year and it has become a fun way to wrap up a week socializing with colleagues. It has been on the 4th Thursday of most months.

04/27

Letter from the Chair-Elect (continued on page 5)

F(rom the Chair-Elect, con’d from 4)

We have tried various locations and are always open to tweaking the format, even switching the night of the week every so often. It does take much work (mostly volunteer), time, and energy to keep this treasured organization running! We are always excited to suggest to membership that serving on a committee or applying to serve on the Board are exciting ways to network with other members, contribute to the functioning of the organization, give back to a group that perhaps has benefited you in the past or present, and apply some of your talents.

We have eight standing committees - Communications, Development, Finance, Membership, Nominating, Programming, and Social Justice. These committees, along with an Ad-Hoc Committee focused on implementation of the 2023 Reset and Revision statement, serve as the backbone of the functioning of NPI. We are excited to be at this particular juncture: to be able to look back on the formation and sustenance of NPI and at the same time to look forward to the possibilities of what the future holds for this organization. We are grateful to the founders who had the vision to support and connect psychotherapists and thrilled to have new and established members join us in this ongoing journey.

05/27

COMMITTEE INFORMATION

Promotion on Social Media Logo/Link on NPI Website “NPI Community Partner Spotlight” distributed to over 1,000 individuals Networking & Promotional Opportunities at CE Meetings Access to attendee contact list

06/27

COMMUNITY PARTNERS

NPI COMMUNITY PARTNER SPOTLIGHT Tapestries Counseling Center provides "Counseling services for healing and growth in a safe and affirming space.”

To that end, Tapestries Counseling Center seeks to “compassionately empower people to accept and love themselves and others inclusive of their age, sexual identity, faith, and relationship status."

Tapestries was born in November of 2022, incorporated as Tapestries Counseling Center, a 501(c)(3) non-profit. While we are located on the property of a church, we are not a Christian Counseling Center. We’re a Counseling Center. We provide counseling services for adults, children, adolescents, couples, and families in an inclusive space. ​ Tapestries is situated on beautiful acreage with trees, flowers, pathways, and gardens. Learn More Here.

07/27

COMMUNITY PARTNERS

The RSD of ADHD

by Dr Douglas Herr

I once dreamt of slowly picking up a paring knife in my left hand, placing it on my temple, and driving it home. That was the night after my therapist recommended I start medication for ADHD. I believe that was also the leading edge of Rejection Sensitivity Dysphoria (RSD), the core of which, I hypothesize, is judging one’s self relentlessly in anticipation of trouble, and in an effort to ward it off.

Looking back now, since grad school, everyone knew I had ADHD. I even got a plaque from my peers that said “Organizationally Impaired.” It was funny, but hidden in the back of my mind, I was doing everything in my power not to be the punchline of a joke. Don’t get me wrong, I told some of the jokes myself. I can do subatomic particle physics, but I can’t find my socks... My private reality: I was embarrassed, because I couldn’t seem to do simple things.

I saw my ADHD as the enemy, and I lived to make it irrelevant. I thought ADHD was a defect, something alien and bad. But, as the Bard put it, “Tis nothing good nor bad, but thinking makes it so.” Though RSD is not part of the ADHD diagnosis, 30% to 50% of people with ADHD experience it. I’ve judged myself harshly my whole life, thinking it was because I’m a recovering fundamentalist or due to intergenerational trauma. A desire not to be judged is something almost anyone feels, but with RSD it’s central. Meanwhile, I tried to be competent in a way that was at odds with my biology, so I could never succeed. ADHD was something wrong with me, and I didn’t want others ever finding out how messed up I really was. I didn’t even want to know how messed up I really was.

Here’s the problem. I am ADHD. I may have anxiety or RSD at times, but I am ADHD; I am neurodivergent, the odd one out. Yes, ADHD causes me struggles, but it’s much more than a defect only. It’s also part of my gifts, the deepest medicine I bring, and key to my life purpose. Instead of judging my ADHD, I’m learning to be proud of who I am, and how I am in the world. As my beloved friend Pete Wright’s recent book puts it, I’m learning to be “Unapologetically ADHD.” (Published by Wiley) Here’s the crazy-good news. I found a way to stop my RSD. This past spring, in a couple weeks, I became ADHD without the Dysphoria. Skeptical? I was, and I lived it. In a few days, my RSD shifted so dramatically it’s like it wasn’t there. How does a lifelong pattern of RSD shift in 2 weeks when countless years of therapy didn’t do it?

Here’s how I did it. I’ve been studying habits and neuroscience for years. In April, I decided to get creative and figure out a way to finally get myself exercising consistently. I spiced up James Clear’s stuff (Atomic Habits) with some cool neuroscience stuff (Habits of a Happy Brain), and it worked flawlessly. Cool. I didn’t miss a day of exercise for months, but the big result was that in less than 2 weeks my self-confidence shot up. I developed a peaceful confidence in such a short time that it blew my mind. Crazier still, the peace has lasted.

I’ll never be the same.

08/27

Douglas Herr Coaching & Consulting

(Doug Herr, Con’d from page 8)

Now, my focus as a coach is working with adults with ADHD and relieving their RSD while improving their self-care. I created a new belief in myself. I can now handle the simple stuff, even with my ADHD brain. I watched myself do it. My self-criticism lost power overnight. My fear of others' criticism has considerably faded, too. Turns out, it’s okay if someone else doesn’t accept you, when you accept yourself.

What I did was make change easy, and since it worked so well, I had to see if other people would have similar experiences. I checked my caseload for people with ADHD, and two clinicians, Dodge and “Lisa”, referred adults with ADHD distress to me. Every client who participates is having a powerful experience with the ritual program.

I asked 3 people to report a confidence level before they started, and they each said “2” out of 10. After a couple of weeks, they reported confidence levels of 7, 7 and 7 ½. I believe the mechanism of change has to do with the power of carefully designed Rituals, which include mind, body and connection in support of their steps toward health and wholeness.

In the remaining paragraphs, I’ll explain exactly how I did it, and why I believe the use of Rituals, used for millennia by religions, is a strategy worth exploring for anyone, but certainly for anyone with RSD. I hope you’ll learn to use Rituals in your own life and with your patients. There’s little new here. I’m just re-purposing what we as a species have already proven, though we seem also to have forgotten. The ancients didn’t have controlled experimentation, but the yogis, monks and priests did have organic, well worn strategies. ********************************** After being faculty at Osher as a Health Psychologist, I trained in Ontological Coaching. We used the “OAR” model for how people change. If a client Observes (O) differently, a new field of possible Actions (A) arises, and different Results (R) flow naturally. That’s the OAR model. So the question is, how do we change the Observer?

As linguistic beings, we observe through language. Change the language, and you change the Observer. The most powerful thoughts we have, thoughts with a strong somatic influence, are beliefs. A new thought may influence, but an old belief is very powerful in controlling our perceptions and actions.

I tore a page from my diary and compared notes with dozens of ADHD people, diagnosed as adults (more likely to have RSD struggles the way I’m conceptualizing them) and surveyed them. “Do you struggle with overthinking and get stuck in inaction? Avoid important things as they get worse? Feel antagonized by a harsh self-critical voice? Do you worry about how much your self-sabotage is costing your life?” They all resonated with those questions. We were all the same in the same boat, save one who was well adjusted.

Continued on page 22

09/27

Douglas Herr Coaching & Consulting

CEUs Approved for 3.00 contact hours for Ethics and 2.00 contact hours for Suicide Prevention

Attend BOTH Sessions and SAVE BIG!

ATTENDEES CAN CHOOSE TO REGISTER FOR ONE OR BOTH THE ETHICS OR SUICIDE PREVENTION PORTIONS OF THIS WORKSHOP. THERE IS A DISCOUNTED REGISTRATION FOR ATTENDING BOTH SESSIONS. Session I: “Prejudice and Suicidal Clients" Time: 9:00 - 11:00 am Presenter: Dr. Erin Carney, PhD Session II: "The Ethical Frontier: AI Integration in Counseling" Time: 12:00 - 3:00 pm Presenter: Jay Tift, PhD, LPC-MHSP

10/27

ETHICS/SUICIDE PREVENTION WORKSHOP INFO

My Friend Warren: Remembering Warren Thompson

by Vida Sobie, PhD vidasobie@gmail.com I couldn’t let the year pass without noting the death in April of my friend Warren Thompson. Warren was a long-time Nashville psychologist, as well as supporter of NPI. We met in 2005, when I was hired in the counseling center at Vanderbilt University, where Warren generously gave of his time and talents as a clinical supervisor. Back then I was trying to put my life back together, after it had been blown apart in New Orleans by Hurricane Katrina. In a matter of days, I had lost my home, my possessions, and my job. I landed in Nashville, and in dizzying short order, was hired at Vanderbilt, bought a house, and became pregnant.

For some reason, Warren looked at my frazzled self, and took me under his wing. On our first luncheon, he took me on an introductory driving tour of Nashville; the most important stop was the house on Woodmont Boulevard in which he and his wife Lynn raised their three children. Warren talked with both pride and grief of his ties to the house; it was where they were living when Lynn died after a prolonged course of cancer.

Other invitations from Warren followed. He invited my husband and me to his home for dinner and cooked us his “famous” biscuits. I can still see Warren wearing oversized oven mitts and serving from the cookie sheet. His Academy Award parties were legend, and here was Warren the bon vivant, in a tux, serving champagne and popcorn. We socialized with Warren and his long-time girlfriend Kathy, and I saw his tenderness and care for her. Indeed, as I write these reminiscences, I’m aware that Warren had so many facets, and I only saw a very few of them. It seemed he knew a legion of people indifferent roles he inhabited: father, grandfather, brother (Warren was a twin!), widower, son-in-law, husband, friend, boyfriend, therapist, supervisor, biking buddy, golf partner, Florida beach bum, volunteer, and on and on.

Over time, our lives took us in different directions: we both left Vanderbilt, but I would still often see Warren at the Y in Green Hills, until the pandemic. We then became Christmas card friends, yet when I didn’t get a card from him this year, I truly didn’t think anything of it. It was a shock to learn of his death, followed by the sadness of loss. Warren and his quick wit were so vital, I always imagined Warren would be “out there,” doing his thing. While Warren may have passed into another realm, I prefer to think of him as I saw him once: driving his antique car, top down, along White Bridge Road, on a sunny autumn day, with a look of utter contentment on his face.

Warren’s last presentation for NPI was in 2012, and I attended. Given this essay is my way of saying good-bye to Warren, it’s ironic the title of his talk was “How Can I Help You Say Good-Bye?: End of Life Issues in Psychotherapy.” It was clear that Warren was imparting his hard-earned wisdom from the untimely death of his wife, Lynn. It was touching to hear so many NPI community members reminisce about her and support Warren. I don’t remember many details about his talk, but his main message was explicit: do not dismiss, minimize, or prevent people from talking about their deaths. I have heeded this message many times in my work, and my life, since then, including when my own father lay dying in hospice.

A client in my practice recently disclosed to me that a cancer he thought had been in remission had recurred, and that his prognosis was troubling. I care for this man, and his news scared me for him, and triggered my own existential fears. I found myself preparing to jump in with some utter crap about only having the present moment, none of us knows what is going to happen, etc. When he said, “I am afraid I may not get out from under it this time,” I thought of Warren, and shut my mouth. Our eyes locked, and I felt my client’s fear between us, like a living thing. We both silently held the gaze for about 20 seconds. It was a sacred moment.

The through-line in these memories, I realize now, was Warren’s utter authenticity. In a business where clients, and therapists, can get all up in their heads, he was ever practical and met people where they were. Warren once told me that he had his children rehearse their roles in the program in advance of Lynn’s funeral, so that at least in one small way they would know what to do—what a grounding gift to give them, even in his devastation. His initial overtures in our friendship could be seen as “welcome the stranger,” or, more simply, do the right thing. A close friend of Warren’s told me that in his final days, Warren made sure to call him, and others, to say good-bye.

That was Warren: a mensch, a Southern gentleman, a class act.

11/27

Warren Thompson Obituary

Contradict Yourself to Be a Better Therapist

By David Sacks, PhD david@nashvilleperformancepsych.com

Any competent therapist surely has some principles that guide their work - a belief system informing their actions and words from one moment to the next. Take, for example, the notion of expertise. Perhaps you view yourself as an expert who has studied long and hard and accrued many hours of practice to build your skills.

Or maybe you prefer not to claim expertise over your clients but, instead, view them as experts on themselves. The latter stance conveys a degree of humility and will prevent you from committing sophomoric mistakes such as telling clients how they ought to feel about their own lived experience.

That being said, denying that you have any expertise at all would be to extend your humility to an unfortunate extreme. Although you cannot really know what it’s like to be your clients, you are well suited to know something that they cannot know: that is, what it’s like to be in a relationship with them. To wit, just as we don’t know how we literally sound to others until we hear a recording of our voice, a client is limited in knowing how they come across to the people in their lives. As a therapist, you bring expertise in this manner, and to deny this is to sell yourself short and to limit your effectiveness. How unfortunate it would be to deny feedback to a client about something you notice - simply because you do not want to acknowledge your expertise.

Additionally, with experience, therapists gain skills in recognizing insight gaps among their clients. For example, if you’re working with a client who displays narcissistic features, you will likely surmise some insecurities in them, though their defenses prevent them from noticing this in themselves. They may see themselves as supremely confident, while you experience them as insecure. What to do about this discrepancy is another matter. However, therapists would be remiss to defer to their clients’ self-view in all situations.

None of this is to say we ought to abandon our sense of humility and always assume we know our clients better than they know themselves. That would be foolish arrogance. Rather, in deciding whether to be humble or confident, the best approach is to choose both – and to lean further into one side of the spectrum or the other based upon the specific situation at hand. In effect, I’m recommending that we contradict ourselves, advocating for one approach in a given circumstance and adopting the opposite in another.

The false dichotomy of confidence or humility is only one of many dualisms we face as therapists.

Others include validating clients versus challenging them, listening versus advice-giving, and being directive versus more passive in guiding a session. (Continued on page 19)

12/27

NASHVILLE PERFORMANCE PSYCH

CHANGE

By Linda Odom, PhD

If I could go to the Wizard of Oz, I would be like the Cowardly Lion And ask for COURAGE. I am reminded of the title of an Al-Anon book: THE COURAGE TO CHANGE. I dreamed recently of a large glass jar in which I had been collecting change.

I was taking out of the jar all things that didn’t belong, like plastic bags and baked potatoes.

My daughter, who is getting married in 17 days, reached in and took a handful of change.

I didn’t want her to take it.

I am a Taurus.

I want to hold on to things as they are.

I notice the joints of my fingers are stiff and sore.

I imagine from holding on to things so tightly.

If only the wizard could give me a potion that filled me with the courage to let go.

If only I could be curious and excited about CHANGE. About possibilities.

About renewal and new beginnings.

If only I believed I could fly.

13/27

LINDA ODOM

Are the Kids Alright?

Empowering Trainees and New Clinicians in Nashville

by Erin Carney, Ph.D. on behalf of the NPI Social Justice Committee As Nashville grows, it is more important than ever to examine how we are actively promoting the wellbeing of therapists-in-training and early career professionals. We all know the burden of paying for graduate-level education and have felt the rising cost of housing, food, and other basic aspects of living in the Nashville area. The newest additions to our profession, however, are disproportionately impacted by these stressors, which has concerned NPI members of all career stages. We’ve posed the following questions for your consideration: How can we make fee splits as equitable as possible to both practice owners and their newest clinicians?

How can trainees from marginalized communities afford out-of-pocket costs for supervision with culturally competent clinicians?

If a pre-licensed provider starts their career in a non-salaried setting, how do they pay their bills as they build their caseload, especially if they are a single income household?

What motivates newly graduated clinicians, who have just spent 2-7 years in academic training, to pursue expensive professional certifications (e.g., paying hundreds to thousands for additional training in a specific clinical intervention)?

If an early career clinician pursues a job in a busy academic setting, medical system, or one of the many new behavioral health companies in Nashville, how can we ensure they continue to receive quality supervision and professional development? How will they be protected against exploitation of hours and pay? How can we protect them from unsafe working conditions?

Ultimately, a growing city means a growing mental health community: more opportunities for collaboration and the enrichment of the quality of care experienced by clients in Nashville. We cannot provide strong care if our quality of life is poor; let us work together to find answers to the above questions and promote the wellbeing of our newest colleagues who are struggling to build a career in Nashville. If you value this issue and others like it, please feel free to share your perspective to any NPI member or take action by joining NPI’s Social Justice Committee.

14/27

Social Justice Committee

WISDOM CIRCLES

by Kenneth Robinson Imagine a place you could go, arriving just as you are—shook-up, broke-down, hurt, mad, lonely or filled with joy, love, elation—and be received, supported, listened-to. No judgment, advice, comparisons. No self-improvement goals. No money involved. Just the warmth and support of kind fellow travelers.

For the past 12 years, maybe more, for one night each month, I have been favored to have just such a place. I think we started out calling it a Wisdom Circle, but the good news was that I didn’t have to be wise to participate—just open and curious.

I’m not a joiner. I’m shy and introverted. But the devotion to the heart that I have witnessed in this group of friends—these colleagues, psychotherapists, NPI members—has kept me coming back month after month, year after year. They know me; they accept me; they even seem fond of me. I am very fond of them.

Given the longevity of the group, we have, of course, been together through many changes. We’ve lost two precious souls to the grave. (Though they do from time to time make appearances.) I feel an ache and a tenderness recalling the many gifts that have come my way by being a part of this circle.

Of course there’s no way of knowing how another group with different characters and circumstances would fair. But our simple recipe—honest sharing, mutual respect, no cross-talk (OK, some cross-talk)—seems to have made for some pretty good cake. I encourage you to try the experiment with others in our healing community.

These are hard times.

15/27

WISDOM CIRCLES

“What Can I Give You to Help You Give Me What I Want?”

A Review of The New Rules of Marriage: What You Need to Know to Make Love Work

by Terrence Real

By Philip Chanin, Ed.D., ABPP, CGP Board Certified Clinical Psychologist/Assistant Clinical Professor, Department of Psychiatry Vanderbilt University Medical Center philchanin@gmail.com “We are drawn to people whose issues fit perfectly with our own in a way that guarantees a reenactment of the old, familiar struggles we grew up with. We all marry our unfinished business. You may think that a good relationship doesn’t bring to the surface every hurt and anger you’ve ever carried inside. But it does.” (p. 45) “Real intimacy is born precisely out of the impact of your human imperfection with mine and how we both handle the maddening, endearing, challenging, and creative collision.” (p. 48) “The only part of the relationship that is under your direct control is you—and that is on a good day. Give up the mad agenda of ‘getting’ your partner to change and try changing yourself instead. While you cannot directly control either your partner or your relationship, you may be able to influence them both by experimenting with radical new moves of your own.” (p. 77) “In the repair process, the listener has only one goal: to help the speaker move back into harmony, to help him or her feel better. The listener’s attitude is: ‘I am at your service. How can I help?’ Anything else will be perceived as at best extraneous and at worst infuriating…Whenever you shift attention away from your partner’s concerns over to your own,you create a situation in which there are two speakers and no listeners.

And that is precisely how most of us do it, how we try, and fail, to effect change.” (p. 208) “When we cast a cool eye over the so-called listening most of us claim to do, it turns out that we’re most often not listening at all. Whether it’s out on the table or locked in our heads, what most of us do, sentence by sentence and point by point, is argue. Then we have the gall to get ‘frustrated’ by mates who are being ‘difficult,’ when in fact we haven’t really appreciated a word they’ve said. Finally, we answer most of their concerns by discounting them altogether or by replacing those concerns with our own.” (p. 212) When patients contact me about starting couples’ therapy, almost universally they say that they need help with “communication.” Very few couples who present for therapy know how to listen. Instead, as I have quoted Terrence Real just above, “what most of us do, sentence by sentence and point by point, is argue.” My goal as a couples’ therapist is to help them have “constructive conversations” instead of useless arguments.

Real describes healthy self-esteem: “Self-esteem is your capacity to recognize your worth and value, despite your human flaws and weaknesses. Your value as a person isn’t earned; it isn’t conditional; it can’t be added to or subtracted from. Your essential worth is neither greater nor lesser than that of any other human being.

It can’t be. Self-esteem is about being, not doing. You have worth simply because you’re alive.” (p. 135) Real introduces the idea that partners must take turns in resolving conflicts. He writes, “Overwhelmingly, our common approach to problems is have a dialogue: You tell me your side and then I’ll tell you mine, and then we’ll thrash is out together…For most couples, any intensely charged issue quickly reveals that the that’s your side, here’s my side approach carries a high risk of increasing rather than decreasing tensions because neither side feels sufficiently heard or understood. In a great relationship both you and your partner can, if you must, air your upset about an issue, but not at the same time.” (p. 207)

16/27

CONTINUED ON PAGE 17

(Philip Chanin, Con’d from page 16) Real continues, “The repair process is unilateral, not mutual. One partner asks for and receives help from the other in order to move out of a state of acute discontent (disharmony) back into the experience of closeness and connection (harmony). The listener must put his or her own needs aside…someone experiencing distress, even if he’s intent on making things right, isn’t really interested in your thoughts, your feelings, or your reasons or explanations. In those first raw moments of reconnection, the upset partner doesn’t care all that much about you one way or the other. What he needs to know if whether or not you care about him.” (p. 207) Real adds, “Once you have demonstrated your care and sincerity, once you have addressed his concerns, then he might have an interest in you. But before that occurs, a distressed partner will inevitably perceive any bid on your part to focus on your experience as a deflection. And though you may have nothing but the best of intentions, he will see your behaviors as defensive, ungiving, selfish, or evasive. And, by the way, he’d be right!” (pp. 207-208) Real elaborates on this point: “The truth is that when most of us engage in so-called listening, we have a hot nanosecond’s worth of attention span before we’re off and running. And just what are we off and running to?

Rebuttal. ‘Geez, that’s not right,’ we might say, or ‘Hey, I never said that. That is such an exaggeration.’ Or, if you’re a psychologically sophisticated couple, you might sound something like this: ‘Honey, that’s your projection.’ ‘No, dear, it’syour denial.’” (p. 212) Real addresses the most profound question for troubled couples: “What’s best for your children?” He writes, “We are living in very conservative times, and a lot of emphasis has been put on preserving families at all cost.

That’s simply unreasonable. Yes, children are damaged by divorce. There’s no question about that. The real question is, how damaged are they by staying in miserable homes?...As bad as divorce is, a child would be better off without the exposure to yelling and fighting and a blatantly disturbed environment. Few people argue that point. So now the question ratchets down to this: How damaged do children get in homes with a miserable marriage that is more contained? Many would argue that children are better off in such environments than with divorced parents. As a family therapist, I must say that I’m skeptical…It’s not at all clear to me that the so-called contained or hidden misery in nonexplosive marriages is really as hidden as we might like to think.” (pp. 268-269) Real continues, “Even if you were to convince me that children in such homes were less damaged in general, I will nevertheless guarantee you that they will sustain considerable damage when it comes to having healthy relationships of their own in the future. Almost every troubled relationship I have ever worked with was a replay of some aspect of the troubled relationship each partner grew up with…Even if it were proven somehow that children are more damaged through divorce than through remaining in homes with unhappy marriages, it is not at all clear to me that the moral imperative is for adults to sacrifice living healthy lives for the sake of their children. I have helped unhappy couples break up; I also have helped them stay together precisely for the sake of the children.” (pp. 269-270) Real concludes, “In extreme circumstances, the choice seems clear. In less blatant situations I mistrust anyone, frankly, who claims to be able to tell you what’s best for your children, or for either of you for that matter. You must decide. Think long and hard; talk it out with those you trust, and listen to what you feel. In the end, most people I’ve encountered over the years who have been through this decision rarely speak about what they should have done, one way or the other. They speak about what they felt they had to do.” (p. 270) Next Real asks, “When should you pull the plug?” He writes, “It serves no one’s interests to preserve endlessly toxic interactions. Addicts and abusive partners can be helped, and the first step should always be an ultimatum: Get treatment or else! But if someone simply refuses, or if he won’t allow his treatment to be effective, I don’t think there’s much choice. I firmly believe that any two partners who love each other and who are willing to do the work can transform even a terrible relationship into a good one, and even into a great one over time. Once both partners are at the table in good faith, anything can be worked out.

(Continued on page 19)

17/27

DR. PHILIP CHANIN

SACRED CHALICE

by Barbara Sanders, LCSW

Chaos, violence, pestilence and Bright white smattering light Connected between human bodies Mother Earth, and Spirit Extremes and juxtapositions Longing for the beams of bright Denying, avoiding or resisting The dark blackness of density Ushering us into a new time A New Earth A Sudden Transformation That takes its time Moving slowly across the desert Slouching towards Bethlehem Through war, famine, rape Murder, quenching only slightly The traumatized authoritarian rulers Who demand utter loyalty and Blind devotion, a Mockery of Christian values Make humanity great again?

Humans have always been dark and light Hungry for food, shelter, sex and Power, filling our appetites to the brim Horrific tragedy and trauma Flowing over from this sacred chalice A biological correction begins Destroying the old, celebrating the new The phoenix finally dives toward The earth, dashing herself into the Ground only to burn into glowing ashes To become reborn so differently Than ever before

18/27

BARBARA SANDERS

(David Sacks, con’d from page 12)

Welcome onboard, John!

It is tempting to seek hard and fast rules to reduce the inherent uncertainty involved in therapy, but holding rigidly to a set of beliefs will limit our effectiveness. These notions form the main premise of a book I’ve recently co-authored with Olympian Ben Askren and CEO Joe De Sena called Extreme Balance. It’s a sport psychology book focusing on how champion athletes and coaches navigate the various contradictory principles in their domains, in which success often depends on balancing oppositional ideas.

Although therapists are not athletes, our occupation similarly offers no single, surefire way to be effective in all circumstances. We can pretend otherwise and cling to a single set of beliefs or, instead, embrace the reality that doing our best work requires continually adapting our approach and, indeed contradicting ourselves to serve all of our clients.

(Philip Chanin, con’d from page 17)

The one thing that cannot be worked out, however, is getting both partners to the table. They have to take their places themselves. That doesn’t mean that pressure can’t be exerted. On the contrary, it absolutely should, and depending on how bad things are, as much pressure as is reasonably possible.” (pp. 270-271) In concluding this book, Real shares about his own journey: “As a young adult I was plagued with writer’s blocks, self-defeating behaviors, oscillations between feeling gifted and cursed, grand and worthless. I began what turned out to be years of healing work; I became a therapist myself. I was doing all right, but I felt I had more in me to give and no idea how to bring it out into the world. But I was healthy enough to ask for help.

Over the years several wise and wonderful people have mentored me, and every one of them gave me his or her version of the same advice. Call it grace, call it power, intuition, inspiration, the sweet spot, or the flow state—call it anything you like. But whatever it is that flows through you in that wonderful state, don’t call it yours. Don’t take credit for it. Don’t act as if you own it. And don’t shrink away from it, either, from its scale or its power.” (p. 277)

19/27

CONNECTION RETREAT

20/27

UPCOMING EVENTS

(Letter from the Chair, con’d from page 2)

Andrew Krichels, Director of Creative Action Seminars; Jackie Welch-Schlicher, Owner of Visions Manifest Coaching and Wildhair Pottery – “Techniques for Living a Grounded, Centered and Creative Life in an Aging Body” Eboni Webb, Psy.D. “The Timeless Wound: Understanding Trauma’s Hold on Past, Present and Future” I hope most of you were there for these wonderful presentations. They were a great experience and well worth the time and attention. And thank you, speakers, for your generosity and for sharing your gifts of expertise, knowledge, perspective – and time. (And I’d like to give a special thank you to John Nichols, LPC, for preparing a presentation as backup in the event of a last-minute cancellation). **We have a lot more coming up before the end of the year! ** Jamie Kyne, Ph.D., and Tom Neilson, Psy.D. “Time, Transformation and The Diamond Approach” Sign up soon for the Jules Seeman Fall Workshop on October 26th. Presenting are two more wonderful people: Mai Ferrell, L.C.S.W., LADAC II, CCTP and Karen Moran, LADAC II, NCAC II, QCS: “That Was Then, This Is Now: How fear and countertransference impact our clients and our work with SUD.” On November 16th we will host our second annual Ethics and/or Suicide Prevention Workshop with Erin Carney, Ph.D., and JayTift, Ph.D., This year’s focus will be on “Prejudice and Suicidal Clients” and “The Ethical Frontier: AI Integration in Counseling”. You can join us for one or both segments.

On December 12th we will end our year with NPI’s Annual Holiday Party and Raffle! I hope to see you there!

Finally, thank you to Tom Neilson for asking me to be your Chair-Elect. I’m glad I accepted the three-year commitment of Chair-Elect, Chair and Immediate Past Chair. So far it has been an interesting combination of challenges, fun, and ongoing learning!

I’ll be forever grateful.

21/27

BOARD OF DIRECTORS

(Doug Herr, Con’d from page 9)

The ROAR model of change that I’ve observed simply takes a Ritual (R) and puts it in front of OAR. Why? A Ritual changes the Observer quickly and easily; that’s why religions all used them. For people with ADHD, daily action and connection are a powerful influence on neuroplasticity. Although some conceptions of Ritual are more elaborate, here’s what I’m doing: we change our behavior (1) and our language (2), we do it repeatedly (3), and we do it together (4). This is how I’m defining a Ritual. A ROAR Ritual is a personal habit specifically designed to use neuroplasticity to set one’s tomorrow self free from yesterday’s limitations and create a growing wholeness.

Here’s a specific example of what I did myself: I picked a habit that’s easy for me to do daily, 25 pushups.

Then I created declaration mantras to address competence and worthiness. Finally, set up daily accountability to make sure it provides belonging. We are inter-beings. We do not succeed alone.

Here’s my 25 pushup Ritual: 1. I take 3 slow breaths (physiological change assists with neuroplasticity), focus on my body sensations and say out loud, “I’m committed to doing this to enjoy being active and feeling good.”

2. Immediately do 25 pushups. (My brain sees me fulfill a promise to myself, implying competence and that I am worth keeping a promise to.)

3. I take 3 slow breaths again, feel my body, and say, a. “I did it.” (Completion. I’ve succeeded.) b. “I’m becoming someone who is fit and active.” (Loving my tomorrow self.)

4. Reach out and relate my experience to my accountability partner.

Here’s my thinking. Our brains are 95% powered by unconscious habits. The rest of the power lies in emotions. We harness our emotional energy in a positive way to make baby step progress consistently. Every day we contribute to tomorrow’s emergent brain development. The self that succeeds is a new self, competent, worthy, and connected.

What surprised me wasn’t that it worked, but how well and how fast. Is there a catch? Sure, here are a few.

One person I work with is so traumatized that he can’t feel his own body. His progress is slower. This technique is likely best with ADHD people who have a pronounced tendency to avoid difficult tasks. They may call it procrastination, but it’s really neurodivergent overwhelm, a precursor to neurodivergent burnout.

They were likely diagnosed in adulthood or didn’t receive proper support in their childhood.

When such people use a Ritual designed in the above manner, they see themselves achieving what always felt impossible. It’s amazing how quickly the stab of self-criticism gives way to relief when I used Rituals.

When I started ROAR, I started with one habit, one mantra. By 90 days, I had a dozen Rituals. If you or your clients struggle with ADHD, I’d be happy to have a conversation about how the ROAR Formula might help.

22/27

Douglas Herr Coaching & Consulting

Reflections on the FDA Denial of MDMA-Assisted Psychotherapy for PTSD

By Tom Neilson, Psy.D.

In August, the Food and Drug Administration (FDA) declined to approve MDMA-Assisted Psychotherapy for Post-Traumatic Stress Disorder (PTSD). This decision was based largely on the conclusions of the FDA Advisory Committee, which voted overwhelmingly against approval. The negative Advisory Committee vote, and the subsequent FDA decision came as something of a surprise to the mental health community. The FDA had previously designated MDMA as a “breakthrough therapy,” and the FDA helped design the Phase III studies that showed MDMA-Assisted Psychotherapy to be effective in treating PTSD. In two Phase III studies (Mitchell, et al., 2021; Mitchell, et al., 2023), more than two thirds of those who were treated with MDMAAssisted Psychotherapy no longer qualified for a PTSD diagnosis by the end of treatment, and changes in CAPS-5 scores before and after treatment were significant at the P<0.0001 (in the 2021 study) and the P<0.001 level (in the 2023 study). These results are remarkable and frankly unheard of in psychotherapy research. They are even more remarkable given the low success rate therapists typically have treating moderate to severe PTSD. Functional Unblinding. The Advisory Committee’s main concern was functional unblinding. The Phase III studies were double-blind studies, meaning that neither the subjects nor the investigators were told whether the subjects received MDMA or a placebo. Despite the double-blind procedures, almost all the subjects and researchers could tell who received MDMA and who received placebo. This functional unblinding should not be surprising; the acute effects of MDMA are not subtle, and almost anyone would be able to tell who did and did not receive MDMA. While functional unblinding is a valid concern, it appears that a double standard is being applied here. In antidepressant research, the side effects of antidepressants can tip off subjects and researchers about who received the medication and who received the placebo. For example, in one study of bupropion for smoking cessation, participants who guessed that they were assigned to the bupropion group were more than twice as likely to have been given bupropion, and participants who guessed placebo were more than twice as likely to have been assigned to the placebo group. (Schnoll, et al, 2008). In these subjects, the double blind clearly failed. One review of blinding, primarily in antidepressants, found that blinding is largely unsuccessful in both subjects and investigators. In addition, it found that few randomized clinical trials in a range of fields, including chronic pain and general medicine, report information about the success of blinding.

23/27

Continued on page 24

(MDMA, Continued from page 24) Only 4.7% of the antidepressant studies they reviewed assessed blinding. Interestingly, antidepressant trials sponsored by pharmaceutical companies were less likely to assess the effectiveness of blinding. (Scott, et al., 2022). Given that unblinding happens frequently and is not adequately assessed in antidepressant research, it appears that MDMA-Assisted Psychotherapy is being held to an illusory “gold standard” that is often not achieved in research.

Furthermore, it seems unlikely that these extremely significant results were due to a placebo effect; we have never seen a placebo effect even close to this size in psychological research.

Inclusion of Psychotherapy. A second concern of the Advisory Committee was the inclusion of psychotherapy in the drug approval process. The FDA has never approved, nor been asked to approve, a drug in combination with psychotherapy. Traditional psychiatric medications are designed to work on their own, although many patients receive medication combined with psychotherapy.

The Advisory Committee’s objection to the inclusion of psychotherapy reflects a lack of understanding of this new and revolutionary treatment model. Therapists with experience treating moderate and severe PTSD know that therapy often fails because the patient cannot tolerate the intense pain of working with vivid and often horrific trauma memories. Therapy often triggers flashbacks, nightmares, and intrusive thoughts of the trauma; the limbic system becomes overwhelmed in the treatment process. Therapy grinds to a halt, and many patients quit therapy because of the pain of the process.

Combining MDMA with psychotherapy greatly enhances the treatment process. MDMA downregulates the limbic system, which dramatically reduces fear and anger and allows PTSD patients to participate in psychotherapy with a manageable level of distress. MDMA also allows patients to relax and trust their therapists more completely, which is likely due to the release of oxytocin caused by MDMA. MDMA on its own does not appear to treat PTSD. Many people, including those with PTSD, have used MDMA recreationally at raves and parties. There is no evidence that recreational use of MDMA helps treat PTSD. Based on the above, it is easy to see why it is necessary to combine MDMA with psychotherapy. It is disappointing that this panel of experts did not understand the basic treatment model well enough to recognize this.

Safety Concerns. Another concern of the Advisory Committee was the lack of safety data collected in the Phase III studies. That is a valid concern, but safety data was collected in earlier studies and is arguably adequate. There was a specific concern about adverse events of increased blood pressure and heart rate in some who participated in the studies. However, it has been demonstrated that pre-treatment with the blood pressure medication clonidine effectively addresses blood pressure and heart rate in patients receiving MDMA (Hysek, et al., 2012); the Advisory Committee appeared unaware of this information.

Abuse Potential. The Advisory Committee was also concerned that data was not collected on the abuse potential of MDMA. An MDMA experience is overwhelmingly pleasurable for most people, and concern about abuse and addiction makes some sense. However, tolerance develops quickly with MDMA use. Frequent use of MDMA rapidly becomes unsatisfying, making chronic MDMA abuse and addiction an unlikely phenomenon.

24/27

Continued on page 25

(MDMA, Continued from page 24)

Concerns about abuse seem even more overblown when we consider that drugs with enormous addiction potential, including opioids and Adderall, have been approved by the FDA. Again, there seems to be a double standard here.

Finally, I would like to point out that the Advisory Committee included only one expert on psychedelics, who was the only member who voted to approve MDMA-Assisted Psychotherapy.

Conclusions. In my opinion, the Advisory Committee neither understood nor appreciated the MDMA-Assisted Psychotherapy model. They also applied egregious double standards in their decision. It may be that MDMAAssisted Psychotherapy is too much of a quantum leap for many traditional mental health experts to understand and appreciate at this time. The model may be threatening to experts who have ties to Big Pharma or who are invested in older and, to be frank, less effective approaches to treating PTSD. The FDA has asked for a third Phase III study, and that study will happen. The FDA decision is also being appealed, but I am not optimistic that the appeal will find sympathetic ears. I am confident that MDMAAssisted Psychotherapy will be approved by the FDA at some point in the future, but the recent FDA decision set the process back two to five years. In the meantime, veterans, victims of sexual assault, and other trauma victims will needlessly suffer, and we clinicians will continue working with our current and less than adequate treatment resources.

References Hysek, C. M., Brugger, R., Simmler, L. D., Bruggisser, M., Donzelli, M., Grouzmann, E., Hoener, M. C., & Liechti, M. E. (2012). Effects of the α₂-adrenergic agonist clonidine on the pharmacodynamics and pharmacokinetics of 3,4-methylenedioxymethamphetamine in healthy volunteers. The Journal of pharmacology and experimental therapeutics, 340(2), 286–294. https://doi.org/10.1124/jpet.111.188425 Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot'alora G, M., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S. S., van der Kolk, B., Tzarfaty, K., … Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature medicine, 27(6), 1025–1033. https://doi.org/10.1038/s41591-021-01336-3 Mitchell, J. M., Ot'alora G, M., van der Kolk, B., Shannon, S., Bogenschutz, M., Gelfand, Y., Paleos, C., Nicholas, C. R., Quevedo, S., Balliett, B., Hamilton, S., Mithoefer, M., Kleiman, S., Parker-Guilbert, K., Tzarfaty, K., Harrison, C., de Boer, A., Doblin, R., Yazar-Klosinski, B., & MAPP2 Study Collaborator Group (2023). MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nature medicine, 29(10), 2473– 2480. https://doi.org/10.1038/s41591-023-02565-4 Scott, A. J., Sharpe, L., & Colagiuri, B. (2022). A systematic review and meta-analysis of the success of blinding in antidepressant RCTs. Psychiatry research, 307, 114297. https://doi.org/10.1016/j.psychres.2021.114297 Schnoll, R. A., Epstein, L., Audrain, J., Niaura, R., Hawk, L., Shields, P. G., Lerman, C., & Wileyto, E. P. (2008). Can the blind see? Participant guess about treatment arm assignment may influence outcome in a clinical trial of bupropion for smoking cessation. Journal of substance abuse treatment, 34(2), 234–241. https://doi.org/10.1016/j.jsat.2007.04.004

25/27

Program Sponsors NPI has been fortunate to have the support of numerous sponsors for our educational programming, which allows us to keep costs low for our members.

Beginning in 2025, we are excited to launch our CORPORATE PARTNERSHIP PROGRAM. This partnership will better emphasize interdisciplinary dialogue and cooperation in sponsoring educational activities in education.

26/27

Corporate Partnerships

NPI ENDEAVORS

PO BOX 158626 NASHVILLE, TN 37215 NpiNashville@gmail.com www.NashvillePsychotherapyInstitute.org

2024 NPI Board of Directors Michael Murphy, LCSW; Chair Tiffany Davis, LCSW; Chair-Elect Tom Neilson, Psy.D; Past Chair Erin Carney, PhD; Social Justice Jill Flowers, LPC-MHSP; Treasurer-Elect Gina Frieden, PhD Laura Fritsche, LPC-MHSP; Membership Krista Gray M.ED., NCC Rich Gorman, NCC, MA, M.Ed. Jeannie Ingram, LPC Tyson Marlow; Student Member

This fall, NPI members will see changes to our publication previously known as NPI Reflects that is distributed to over 1000 therapists, counselors, and students in the Nashville area and posted online. We are excited to rebrand this publication NPI Endeavors as we believe the new name more clearly states the purpose of this publication and eliminates some of the confusion between it and our weekly email blast.

With the focus of this first issue to be Reflections on 2024 and Projections for 2025, we hope to highlight and celebrate our members, our presenters, and their vast experiences, as well as generate excitement around programming for next year.

We hope that you have enjoyed this publication, and that you are making plans to join us in 2025 as we celebrate 40 years of connecting and community!

Tonya Mills, LPC-MHSP/T; Treasurer Doug Taylor, LPC-MHSP; Programming David Spielman, PhD, MSN, PMHNP-BC; Communications Eboni Webb, PsyD, HSP Cathryn Yarbrough, PhD; Hutton Historian Melissa Vickroy, MS; Executive Coordinator

27/27

BENEFITS OF MEMBERSHIP